Genetic Tests for Addiction Risk—Helpful or Harmful?

By May Wilkerson 06/01/16

Critics of genetic addiction risk testing are concerned that the companies creating the tests are merely profiting off at-risk patients. 

Genetic Tests for Addiction Risk—Helpful or Harmful?

When it comes to opioid-based painkillers, could a person be “hardwired” to get addicted? In April, we covered the growing interest in the Proove Opioid Risk genetic profile—a DNA test presented as a reliable predictor of a person's genetic predisposition to opioid addiction. According to Medpage Today, the test is already being used by some clinics across the United States, including the National Spine and Pain Centers, the largest chain of pain medicine facilities in the mid-Atlantic region.

Some, like Dr. Damon Kimes, an addiction and pain specialist in Roswell, Georgia, vouch for the Proove test's effectiveness. But experts in the field interviewed by Medpage are skeptical, and argue that addiction is too complex for risk to be determined by a simple genetic test.

Genetics account for about half of a person's risk factor—40% to 60%. The other half comes from environmental, social and cultural factors, like "being exposed to peer pressure, individual coping skills, chronic pain, depression, the properties of drugs themselves," said Dr. Zena Samaan, who studies the genetics of addiction at McMaster University in Canada. Doctors typically look to these risk factors to assess a patient's risk of addiction to opioid-based painkillers like OxyContin or Percocet. 

But our understanding of the genetic risk of opioid addiction still has some ways to go, which is why people like Samaan are skeptical about tests like Proove, which boasts a 92.75% accuracy in predicting a person's susceptibility to opioid dependence. "We have some good ideas about the genes controlling opioid receptors, and some ideas about genes controlling impulsive behaviors, but these are not the only genes involved in addiction risk," Samaan told Medpage.

Samaan pointed out that tests like Proove only look at a small number of genetic variants (SNPs), but this excludes additional genes that may contribute to addiction risk that haven't yet been discovered. Dr. Mary Jeanne Kreek, an expert in addiction genetics at Rockefeller University, said that "dozens of SNPs" are involved in predicting genetic vulnerability to addiction, and that the idea of determining an individual's addiction risk by looking at 1 or 20 variants "is quite frankly absurd," she told Medpage.

The Proove test, for example, relies on a panel of 12 genetic variants to determine a person’s risk. This information is then combined with more traditional screening methods like the Opioid Risk Tool, which relies on patients' self-reporting of any history of substance abuse and psychological disorders like depression and schizophrenia. 

Overall, it seems "premature" to use these tests for actual diagnostic purposes, experts say. "We are nowhere near having any diagnostic genetic test for a disease as complex as a psychiatric disorder," said Samaan. "We don't have a single group of genes to say this is the culprit, that this is what's causing addiction."

Critics also argue that it's all about profit for the companies churning out the tests, and that they could potentially harm patients if a person's risk is miscalculated. If a patient falsely tests for low risk, for example, they may let their guard down and become addicted, said Samaan. If a patient falsely tests for high risk, they could be denied pain medication they legitimately need.

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May Wilkerson is a writer, comic and Managing Editor @someecards. Co-host of the podcast Crazy; In Bed w/alyssalimp. She is also the top Google result for "insufferable lunatic." Follow this insufferable lunatic on Twitter.